Healthcare Provider Details

I. General information

NPI: 1134034788
Provider Name (Legal Business Name): KAELY ERICKSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 DIVISION ST
MAUSTON WI
53948-1931
US

IV. Provider business mailing address

6211 ARTILLERY AVE
SPARTA WI
54656-8316
US

V. Phone/Fax

Practice location:
  • Phone: 608-847-6161
  • Fax:
Mailing address:
  • Phone: 281-744-7958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: